Provider Demographics
NPI:1083764674
Name:SHAHOVEISI, HESAM (DMD)
Entity Type:Individual
Prefix:DR
First Name:HESAM
Middle Name:
Last Name:SHAHOVEISI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:SAM
Other - Middle Name:
Other - Last Name:SHAVEISI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:8716 CORD AVE
Mailing Address - Street 2:
Mailing Address - City:PICO RIVERA
Mailing Address - State:CA
Mailing Address - Zip Code:90660-5507
Mailing Address - Country:US
Mailing Address - Phone:562-949-2526
Mailing Address - Fax:562-949-9231
Practice Address - Street 1:8716 CORD AVE
Practice Address - Street 2:
Practice Address - City:PICO RIVERA
Practice Address - State:CA
Practice Address - Zip Code:90660-5507
Practice Address - Country:US
Practice Address - Phone:562-949-2526
Practice Address - Fax:562-949-9231
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA477981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice